ACUTE HEMATOGENOUS OSTEOMYELITIS

Abstract

The clinical records of 99 infants and children admitted to the Grace-New Haven Community Hospital with acute hematogenous osteomyelitis are reviewed.

The presenting symptomatology and physical findings are discussed. Detection of localized tenderness is the most significant early clinical sign. This was not, however, a common finding at the time of admission.

The diagnoses entertained in these patients at the time of admission are reviewed and the differential diagnosis is discussed.

The distribution of the bony lesions was similar to that noted by other authors. However, attention is called to the frequent involvement of the bony pelvis.

A specific bacteriologic diagnosis was made in 87 per cent of the patients. In 63 per cent staphylococcus was the etiologic agent. Beta-hemolytic streptococcus was considered the etiologic agent in 18 per cent. Staphylococcus was the most frequent offender in all age groups. In infants less than 2 years of age osteomyelitis was streptococcal in 27 per cent.

The average interval from the onset of symptoms to the development of positive roentgenographic signs was 10 days. The range was 3 to 17 days.

In treatment of patients suspected of having osteomyelitis, vigorous antibiotic therapy should be continued until at least 3 weeks have elapsed since the onset of symptoms. If at the end of that period roentgenograms remain normal and clinical signs and symptoms have been absent for at least 1 week, it would seem safe to discontinue treatment.

A detailed program for medical therapy is Presented and the indications for surgery are considered. Emphasis is placed on vigorous search for the infecting organism. The necessity for intensive treatment given over an extended period of time is stressed.